Piles, Fistulal Fissue [sic], Polypsus, Pru-
ritus, and Rectal Ulceration
Permanently and Pain-
Rectal Ulceration is the most dangerous of
all Rectal Maladies, owing to its undermining
the system before its victims realize their dan-
ger, this being due to the scarcity of nerves of
sensation in that portion of the rectum mostly
SYMPTOMS OF RECTAL ULCERS
Pain or weakness across lower portion of
back, often referred to kidney troubles, burn
ing in rectum, after, stool, itching about anus
attended with a moisture caused by discharge
from ulcer—constipation, sometimes being at
tended with spells of diarrhoea, finally result
ing in chronic diarrhoea when the case is a
lmost beyond cure, but if not too longstanding is
curable. Much and mattery discharges from the
rectum, soreness through the bowels extending
to stomach causing dyspepsia. In females fre-
quently vaginal and uterine inflammation and
ulceration. Make examination and consultation
Write H. S. KISKADEN, M.D., 253 Wood-
ward Avenue, Detroit, Mich, for 58 page pamphlet
H.S. KISKADDEN, M.D.
DRS. KISKADDEN and BRINKERHOFF, will be at
SANDUSKY CITY, West House, Thursday,
April 17, from 8 to 12a.m.
Fremont, Bail House, Thursday, April
17, from 2 to 5p.m.
Source: The Sandusky Daily Register (Sandusky, Ohio) 15 April 1890
There’s nothing unsurprising about the patentees of medicines or devices being out to make money, but Alexander W. Brinkenhoff was slightly different. His market wasn’t the end-user (as it were) but the people who would administer the treatment. For $200 plus a 10% royalty on fees earned from patients, anyone could buy ‘the Brinkerhoff System’ and set up as a travelling practitioner bringing relief to the suffering sphincters of the 19th-century U.S.
This was not a business opportunity for the squeamish. It didn’t involve selling the punter a useless medicine and then making a run for it before they found out it didn’t work. It was really hands-on stuff.
Although the ad above doesn’t focus on haemorrhoids, they were the System’s main target. The secret pile mixture – of which the franchisees had to buy new supplies when they ran out – comprised carbolic acid, olive oil and chloride of zinc. This wasn’t a soothing ointment for the sufferer to apply in privacy – the pile-doctor administered it by hypodermic needle direct to the seat of the problem. Quantities as follows (a U.S. minim = o.0616 ml):
Largest Piles………………………………………..8 minims
Medium “ ……………………………………..4 to 8 “
Small… “ …………………………………………2 to 3 “
Club-shaped painless piles near orifice….. 2 “
You would not have all your piles seen to at once. One at a time, or perhaps two, was quite enough, with the pile-doctor returning 2-4 weeks later to do the next one – by which time the first should have shrivelled up and fallen out. Brinkerhoff only recommended the injections for internal piles, because treating external ones this way would be far too painful. Some pile-doctors, however, got round this by injecting external piles with cocaine first.
When local pile-doctors advertised, they usually described the treatment as painless (or the less reassuring ‘nearly painless’), but Brinkerhoff’s instructions suggested that if agony did follow, hot sitz baths would be beneficial.
Reputable doctors also purchased the System for use in their practices, but some, like Illinois physician Dr Layton, soon realised they had got a bum deal:
As to its being painless, I can say from positive experience that this is far from being the case, as I have had several of my patients hint at a suit for malpractice on account of such excruciating pain and soreness; so that I even forgot to ask them for my bill.
The rectal ulcers referred to in the above ad required a different treatment – carbolic acid was still involved, but this time it was combined with ferric subsulphate solution, glycerine and witch-hazel. A genuine rectal ulcer was as unpleasant as it sounds, but luckily for the pile-doctors, they could diagnose normal anatomical features as ulcers, thus ensuring that everyone needed the treatment:
They [the itinerant doctors] generally show the patient’s friends the rectal fossa and term it a horrible eating ulcer, that is daily destroying the patient’s vitality, and which will sooner or later cause him to fill a consumptive’s grave.
The Medical Waif, quoted in C.W. Oleson, Secret Nostrums and Systems of Medicine
Apologies if this occasions you an image of all your extended family and neighbours clustering round to discover your hidden depths. They should be able to get a pretty good view, however, because the Brinkerhoff kit included a rectal speculum (pictured below). This invention was well-designed and well-made, and Brinkerhoff specula are still in use.
Carbolic acid was already widely known as a treatment for rectal disorders and the Brinkerhoff System was no worse than other treatments of the time, which included the ‘clamp and cautery’ method. This involved drawing the pile out with forceps, clamping it and then snipping it off with scissors. The stump would be sealed with a cauterising iron ‘so applied as not merely to sear the cut surface, but to thoroughly “cook” the whole projecting stump well up to the clamp.’ As Edmund Andrews acknowledged in his highly informative Rectal and Anal Surgery (1889): ‘the idea of burning the parts with hot irons is horrifying to the imagination of the patient.‘
What was unusual about the Brinkerhoff System was the investment fee and royalties for the privilege of using a method that anyone could put together for a few dollars. Even more unusual is the idea that anyone would fancy this as their next career move.